Benign Mesenchymal Tumors of Oral Mucosa

Irritation fibroma* is a common reactive soft tissue enlargement due to chronic irritation or trauma. It most commonly presents as an exophytic, dome-shaped enlargement which may be firm or compressible to palpation. The mucosa overlying the lesion may be normal or ulcerated due to trauma. It is most common on the buccal and labial mucosa. Treatment for irritation fibroma is excisional biopsy and microscopic diagnosis. Recurrence is uncommon.

Epulis fissuratum (inflammatory fibrous hyperplasia)* represents hyperplasia of dense connective tissue due to chronic irritation from the flange of a denture. It appears as an enlargement in the vestibule. Often a fissure will be present in the lesion, corresponding to the location of the denture flange. Treatment consists of surgical excision of the mass and microscopic diagnosis, and usually remaking or relining the denture.

Peripheral ossifying fibroma (peripheral fibroma)*, is a reactive soft tissue enlargement arising from cells of the periodontal ligament. It is always located on the gingiva or attached alveolar mucosa, often ulcerated, and may be red or have a normal mucosal color. It is most common in adolescents through young adults. An interesting feature microscopically is that peripheral ossifying fibroma frequently forms a mineralized product within a cellular fibrous stroma. Treatment is excisional biopsy and microscopic diagnosis. The lesion should be removed down to periosteum. It has a good prognosis although recurrence rates up to 16% have been reported. Treatment for recurrent lesions is re-excision.

Schwannoma* is a benign neoplasm of Schwann cells. It is firm, encapsulated, and often freely moveable. Treatment is excisional biopsy and microscopic diagnosis. Recurrence is uncommon.

Granular cell tumor* is a benign neoplasm previously called granular cell myoblastoma. The tumor cells are of Schwann cell origin. The lesion is fixed to surrounding structures. The most common location is the dorsum of the tongue. Microscopically, the lesion often appears infiltrative, however, conservative excision and microscopic diagnosis is usually curative.

Congenital epulis* is a benign soft tissue enlargement that occurs on the attached alveolar mucosa of infants. Almost 90% of these lesions occur in females. Treatment is surgical excision and microscopic diagnosis. Prognosis is excellent.

Peripheral giant cell granuloma* is a reactive soft tissue enlargement that occurs only on gingiva or attached alveolar mucosa. Treatment is excisional biopsy and microscopic diagnosis. The microscopic features consist of giant cells that are identical to those of central giant cell granuloma.

Pyogenic granuloma* is a soft tissue enlargement that develops in reaction to minor injury or irritation. It can be found on any oral mucosal surface at any age, but is most common on the gingiva in children and pregnant females. Pyogenic granuloma is compressible, can be lobulated and is often pedunculated. Ulceration is frequently present. The initial growth rate is quite rapid. In lesions of longer duration collagen replaces much of the vascularity and the lesion begins to resemble an irritation fibroma. Treatment is excisional biopsy and microscopic diagnosis. Recurrence is not unusual, and recurrent lesions should be re-excised. For pregnant patients excision can be deferred until after the pregnancy is completed.

Hemangioma* is a proliferation of blood vessels which usually is noted at birth or early childhood. It may be well circumscribed or diffuse. The arteriovenous malformation is a different lesion. It represents a direct communication between an artery and a vein, and it will demonstrate a thrill and bruit. A hemangioma requires no treatment unless it is a functional or cosmetic problem. Many hemangiomas will regress spontaneously during childhood. Incision of an arteriovenous malformation may lead to fatal hemorrhage.